Facility Management: Emergency Services

This past March, Tom Dunn of Winchester, Mass. joined three friends for their weekly game of doubles at the Winchester Indoor Lawn Tennis Club.

After battling to 8 games all in an extended first set, 68-year-old Dunn staggered as he went for a ball, causing partner Kerry Bergin to call out, “Tom, are you OK?”

Dunn weakly replied that he wasn’t, then fell to the ground. He awoke three days later at a local hospital.

Dunn doesn’t remember anything about that evening, but Bergin and everyone else who witnessed the incident will never forget it. Instantly recalling a similar occurrence when Dunn collapsed on the town’s outdoor clay courts nearly two years ago, Bergin frantically yelled for a doctor and ran to his friend. Finding no pulse, he told their worried opponents, Brad Steele and former Boston Celtic Steve Kuberski, to call 911 and began administering CPR, which he had learned by watching TV and movies.

“I just reacted. I didn’t have formal training, but Tom started making some noises which was a lot better than what he was doing two minutes before,” recalled Bergin, who relinquished compression duty to Kuberski so he could perform mouth-to-mouth resuscitation when Dunn appeared to worsen. Dr. Paul McKeough, a radiation oncologist who revived Dunn two years ago and happened to be playing on another court, also ran to assist until a team of emergency medical technicians (EMT) arrived with an automated external defibrillator (AED).

Dunn, past president of the Winchester Tennis Association, underwent the bypass surgery, which he had elected to delay two years prior with the hope of reversing his ventricular condition with dietary changes. A computer programmer, Dunn is working from home while he regains strength through physical therapy. He hopes to resume his weekly tennis sessions this fall.

“I’m so grateful,” he said, “and very lucky.”

Train Your Staff

However, not everyone who suffers from a cardiac episode or other serious injury can rely on the kindness of friends and good fortune. According to the Centers for Disease Control and Prevention, heart disease is the No. 1 cause of death for men and women in the U.S., claiming nearly 600,000 lives each year.

Off the court, danger also lurks in fitness facilities. The Consumer Product Safety Commission revealed that in 2009, there were 1,500 emergency room visits due to mishaps related to gym equipment, with treadmills, weight machines and free weights as the biggest culprits. Injuries are commonly attributed to underlying health conditions; inattention due to cell phones, iPods, watching TV and reading; using equipment incorrectly; and working out too aggressively following a period of inactivity.

For these reasons and more, Jeffrey L. Pellegrino, Ph.D., a member of the American Red Cross Scientific Advisory Council, said it is imperative that sports and fitness clubs, coaches and other staff members have access to all the training and equipment necessary to keep participants safe — regardless of whether it is required by law.

“It’s a partnership,” Pellegrino said, based on his firefighter/EMT and instructor experience, as well as his work in developing and facilitating emergency prevention, preparedness and response curricula at Kent State University in Ohio.

“When people walk into a club, its commitment to safety should be noticeable, whether by stocking first aid kits, making sure an AED is in a prominent position, training staff to respond to an emergency or posting the signs and symptoms of a heart attack in the locker room,” he added. “If we can create that culture of awareness, then when an actual event happens, more people will be willing and able to respond.”

Prepare for Emergencies

For those wondering where to start, the Red Cross Ready Rating (readyrating.org) is a free, online program that assists businesses, schools and organizations in evaluating and improving their preparedness for medical emergencies and disasters. The American Red Cross and the American Heart Association also have other resources available.

While a number of private entities also work with companies to train skilled responders and develop comprehensive response plans, common sense goes a long way as well. Club employees and members alike should visually inspect court surfaces and equipment, lighting, the placement of medical equipment and the location of nearby telephones and doors large enough to accommodate stretchers and other emergency gear. In turn, clubs should commit to regular safety audits and careful record-keeping of injuries to prevent reoccurrences.

While no program is perfect, Pellegrino said the key is empowering employees and members alike to learn, practice and ultimately employ the skills required in an emergency until EMTs arrive. “People shouldn’t be afraid to exercise,” Pellegrino said, “but it’s important to provide training so as many people as possible have the competencies to help someone in need.”

Ironically, Dunn said he carried a portable AED he was given after his first cardiac episode in his car trunk for months, until the local recreation department installed one at the outdoor courts at which he played. While club owners may benefit from mitigated risk and lower insurance rates resulting from emergency training and equipment, Dunn — whom Bergin now affectionately calls the “comeback kid” — has a more grounded appreciation for the quick response that saved him.

“I’m just glad to be here,” he said. “I’ll certainly be grateful to my friends for the rest of my life.”

Keeping Your Players Safe

According to the Centers for Disease Control and Prevention, obesity rates have skyrocketed over the past 20 years, with 35.7 percent of adults now at a body mass index (BMI) of 30 or greater. As a result, Americans are suffering from a myriad of obesity-related health issues, including coronary heart disease, stroke, hypertension, Type 2 diabetes, high cholesterol, liver and gallbladder disease, sleep apnea and respiratory problems, osteoarthritis, infertility, mental health conditions and colon, breast and endometrial cancers.

While millions are flocking to tennis courts, health clubs and other facilities to reverse previously sedentary lifestyles, it is the fitness industry’s collective responsibility to ensure they will remain safe while doing so.

Stephen Tharrett, president of Club Industry Consulting in Texas, outlines the steps required for health and fitness establishments to provide high-quality programs and services in a safe environment as a senior editor of the American College of Sports Medicine’s Health and Fitness Facility Standards and Guidelines.

The fourth edition, which was published in February 2012, includes new standards including pre-activity screening, orientation, education and supervision; risk management and emergency procedures; professional staff and independent contractors; facility design and construction; facility equipment; operational practices; and signage.

One example reflecting the evolving business model is the public access defibrillation (PAD) program, which is designed to increase sudden cardiac arrest survival rates by advocating the use of CPR and AEDs within five minutes of collapse. The book also provides sample preventive maintenance schedules, checklists and templates of questionnaires, informed consent forms and evaluations.

Tharrett, a former officer and senior vice president at Dallas-based ClubCorp, said much of the text also served as the foundation for NSF International’s work in developing its Health/Fitness Facilities Standards, as well as a voluntary health and fitness facility certification process which could be introduced in 2014. According to Tharrett, this combined expertise of academic, medical, health and fitness professionals provides a blueprint for facilities to use in enhancing the member experience.

Tharrett, deputy chair of the NSF International joint committee on health and fitness facility standards, said public access to AEDs as part of an emergency response plan has been an industry standard for the past six years. But once an AED is installed, he noted, the facility is required to comply with state regulations governing its maintenance.

In fact, Tharrett estimates the cost of purchasing an AED, certifying 10 staff members to use it and conducting biannual drills to be a few thousand dollars, or the cost of a piece of new gym equipment. It is a particularly good investment for racquet sports facilities, he noted, because research indicates that moderately strenuous physical exertion may trigger ischemic cardiac events, particularly among those not accustomed to regular exercise.

“You’re going to save on insurance rates, and you might also save a life while showing your members you care about them,” Tharrett said. “It’s a win all around.”

What Should You Have In Your First Aid Kit?

It seems logical that wherever people are physically active, a first aid kit should be accessible. But what should be in it?

First aid kits of varying complexities and prices are widely available. Consider these recommendations from the American Red Cross, which offers kits online, when purchasing or assembling one for your workplace, car or home. (Add emergency phone numbers and check the kit regularly for missing or out-of-date contents.)

2 absorbent compress dressings (5 x 9 inches)

25 adhesive bandages (assorted sizes)

1 adhesive cloth tape (10 yards x 1 inch)

5 antibiotic ointment packets (approximately 1 gram)

5 antiseptic wipe packets

2 packets of aspirin (81 mg each)

1 blanket (space blanket)

1 breathing barrier (with one-way valve)

1 instant cold compress

2 pairs of non-latex gloves (size large)

2 hydrocortisone ointment packets (approximately 1 gram each)

scissors

1 roller bandage (3 inches wide)

1 roller bandage (4 inches wide)

5 sterile gauze pads (3 x 3 inches)

5 sterile gauze pads (4 x 4 inches)

oral thermometer (non-mercury/non-glass)

2 triangular bandages

tweezers

first aid instruction booklet

Other Lifesaving Strategies

The American Red Cross and the American Heart Association offer many resources that can help save lives. Some are listed below.

From the American Red Cross:

Hands-Only CPR: Involving no mouth-to-mouth contact, this technique is best utilized when an adult suddenly collapses.

Full CPR: This option, which combines rescue breaths with chest compressions, is best for emergencies involving infants and children, drowning victims and people who collapse due to breathing problems.

Blended First Aid, AED and CPR training: There are certified- and non-certified training options for workplace responders, with full-service training provided onsite by Red Cross instructors.

First Aid, Health and Safety for Coaches: Developed with the National Federation of State High School Associations, the program provides an overview of first aid and best practices for common athletic injuries, such as evaluating an unconscious athlete; asthma management; heat-related illness; injuries to the head, neck and spine; skin conditions and infections; and mental health issues.

First Aid Emergency Drills: This program is designed to test and strengthen a company’s emergency planning, training and response.

First Aid App: Available for iPhone and Android devices, the official American Red Cross First Aid app provides videos, interactive quizzes, step-by-step instructions and one-touch 911 access for first aid emergencies including cuts and sprains, choking, seizures and strokes.

From the American Heart Association:

Heartsaver CPR AED: This classroom course teaches adult CPR and AED use, as well as how to relieve choking on an adult.